Do we accept insurance?

Dr. Ryan Hall, DCN, MS, CNS, LDN is in network with Aetna, though we are only able to work with diabetic patients with medicare or medicaid. 

But you (not us!) need to call to verify and confirm that you do, in fact, have nutritional counseling benefits on your insurance policy. 

This is often the case EVEN if you don’t have an actual diagnosis BUT still want to come in for nutrition counseling for prevention of a disease.

Why not check to see if your insurance policy will cover the visits? Start by calling the 800 number on the back of your insurance card and ask to speak with a representative.

The information below will walk you through the steps to take to see if your insurance will cover the cost of nutrition counseling for your visit.

What questions should I ask when calling my insurance company?

Please note it is the patient’s responsibility to call their insurance company PRIOR to your visit to confirm coverage. I know we sound like a broken record – we just don’t want our patients to have ANY surprise bills. 

Do I have nutritional counseling coverage on my insurance plan?

• If the insurance company asks for a CPT code please provide them with the following codes 97802 & 97803. If they say you do not have coverage using those codes NEXT ask them to check your coverage for the following CPT codes: 99401, 99402, 99403 and 99404. We also can bill for S9470 if it is covered on your policy. 

Will my diagnosis be covered?

• If the representative asks for a diagnosis code (aka ICD 10 code) – please tell them the visit is coded the ICD 10 code: Z71.3

• If they don’t accept Z71.3 then provide them with Z72.4 and see if they will cover that diagnosis instead on your plan. 

• If you are overweight, obese, have pre-diabetes, diabetes, hypertension, or high cholesterol you may want to see what your coverage is for these diagnoses as well. 

• We always code your visit using preventative coding (if applicable) to maximize the number of visits you receive from your insurance carrier. However, if you ONLY have a medical diagnosis (for example: IBS, and you are not overweight or have CVD risk factors) your insurance may impose a cost-share for your visit either in the form of a deductible, co-pay or co-insurance. 

How many visits do I have per calendar year?

• Your carrier will let you know how many visits they are willing to cover. Depending on the carrier the number of visits vary from 0 to unlimited depending on medical need.

Do I have a cost-share for my nutrition visit?

• A cost-share is the amount you will need to pay as required by your particular insurance plan towards your services. A cost-share can be in the form of a deductible, co-pay or co-insurance. 

• We will always bill under your insurance policy’s plan under your preventative benefits if your plan allows. With that being said, if you have preventative benefits there if often NO cost share for you associated with the visit. Once again, this is something YOU do want to ask prior to your visit. 

• In the event you have a  cost-share we will initially bill your insurance company directly.  Once we receive the EOB describing your responsibility as the patient, we will bill the credit card on file for the amount noted under ‘patient responsibility.

• For most insurance companies nutritionists are considered a specialist. Therefore, your specialist co-pay is applicable and is payable at the time of service. This information is often apparent on the front of your actual insurance card. However, often because we bill your insurance with preventative counseling the co-pay is often not applicable.

• We generally wait for the claim to be processed to determine whether or not you have a co-pay and then charge the credit card you have on file with us the co-pay amount. 

Summary of questions to ask to verify your nutrition benefits

• Do I have coverage for nutrition counseling?

• Do I need a referral to see a Registered Dietitian?

• Are my diagnoses covered on my particular plan?

• How many visits per calendar year do I receive?

• Do I have a cost-share for these services?

• Is there an associated cost for me if I choose to have the appointment as a telehealth visit versus in person visit?

What if we don’t accept your insurance?

If we don’t accept your insurance plan, your insurance carrier may offer out-of-network benefits.  If this is the case, we can provide a Superbill (receipt) so you can submit it for reimbursement. 

Can you use your FSA/HSA?

We also accept FSA (Flex Spending Account) and HSA (Health Savings Account) cards. Please note that it is your responsibility to verify coverage for nutrition counseling with a clinical nutritionist (we are not dietitians). Your plan may require that you have a Medical Letter of Necessity for reimbursement.